瞬目反射及面神经电图在Bell面瘫中的临床应用

目的 研究瞬目反射(blink reflex, BR)及神经电图(electrical neurography, ENG)在Bell面瘫中的应用价值。方法 采用海神号神经检诊仪,刺激眶上神经,分别在同侧眼轮匝肌记录出R1波及R2波,在对侧眼轮匝肌记录出R′2波;在茎乳孔处刺激面神经,用同心圆针电极记录出运动潜伏期及M波波幅,对35例Bell面瘫患者行BR及ENG检测,并与自身健侧对比。结果 35例患者BR均有不同程度异常,ENG部分异常。结论 BR与ENG均能反映面神经损伤程度、部位及预后,两者结合的早期诊断及预后判断价值更大。     

面神经断伤吻合后功能恢复变化的实验研究

目的:观察大鼠面部行为、功能学的恢复变化,为面神经损伤修复研究提供可靠的实验性功能评估手段.方法:建立大鼠面神经断伤吻合模型,术后每周观察触须拂动与瞬目等面部运动,记录健患两侧面神经电图(ENoG)与瞬目反射(BR)的变化.结果:术后患侧触须拂动与瞬目动作消失,但立即出现细微的触须颤抖,术后1个月左右面部运动开始恢复,2个月时可出现瞬目动作同时耳周肌肉的联带运动.ENoG检测时,术后患侧复合肌动作电位(M波)仍可引出,21 d时其潜伏期值开始延长,1个月时达高峰并开始恢复,3、4个月时基本稳定但仍不能恢复至健侧水平,其中28～63 d时健患两侧潜伏期值的变化与其他各时间点相比差异均有统计学意义(均P＜0.05).健患两侧M波振幅与刺激强度值变化无明显规律,潜伏期、振幅与刺激强度三值间也无相关性.BR检测时,患侧R1波在术后7、14 d消失,1个月后恢复检出,2个月左右可在同侧口轮匝肌处记录到提示联带的R1样肌电反射波(R1ons),此后两者潜伏期值均减低,而且2个月时的R1ons潜伏期值均长于此后各时点值(P＜0.05).结论:ENoG和BR检测方法客观可靠,可用以反映大鼠面瘫模型的面部行为、功能学恢复变化,进一步完善后有助于面神经损伤修复机制的相关研究.     

神经电图对治疗面神经麻痹的评估作用

为掌握治疗面瘫的时机或方法及评估面神经功能恢复的可能性,寻找简便可靠的检测手段,我院于１９９３年７月～１９９７年７月,经神经电图测试并获得治疗者共２４例,其结果分析如下。１临床资料１．１２４例面瘫患者,男１５例,女９例;年龄最小者８岁,最大者５３岁,...     

Bell麻痹的听力学评估

本文对6例伴耳鸣、眩晕或听力下降的Bell麻痹进行了听力学观察。结果证实这些Bell麻痹病人伴有耳蜗，前庭功能的改变。提示Bell麻痹并不是一种独立性疾病。Bell麻痹病人耳蜗前庭功能改变的原因有待进一步的探讨。     

单纯疱疹病毒1型与Bell麻痹

单纯疱疹病毒1型(HSV-1)能够在宿主感觉神经节内长久潜伏,在某些因素的刺激下再次激活,从而引起各种疾病.关于Bell麻痹的病因一直有很多争论,自McCormick在1972年提出HSV感染假说以来,学者们在基础和临床等方面进行了广泛研究,近年来通过分子生物学和动物模型的研究,大多数学者同意HSV-1感染是Bell麻痹的主要病因之一,其机理可能是由于潜伏在膝状神经节的HSV-1激活造成的面神经炎.     

Bell麻痹的面神经减压疗效评价

目的 评价面神经减压术对Bell麻痹的治疗效果.方法 通过PubMed和《中国医院知识仓库》总库(简称CHKD总库)检索面神经减压治疗完全性Bell面瘫的中、英文文献,收集文中报道的病例,制定统一的准入标准,对入选病例进行统计学分析.参考激素治疗Bell面瘫的效果,评价不同的手术方法及手术时机对治疗效果的影响.结果 通过检索共有5篇文献所报道病例符合入选标准,其中手术治疗例数147例,总治愈率57.10%;激素治疗例数105例,总治愈率为48.90%.发病14天以内全程减压的手术治愈率高达90.70%,而15～30 天之间为25.00%;发病15～30 天之间面神经乳突段减压的治愈率为45.70%,全程减压治愈率为25.00%.结论 面神经减压应在发病后14天以内进行,14天以后手术治疗不能增加疗效;目前没有证据表明面神经全程减压效果优于乳突段及鼓室段面神经减压.     

Bell's palsy and its recurrences

Summary The purpose of this study was to evaluate the incidence and the prognosis of patients with recurrences of Bell's palsy. Yanagihara's classification of recurrent palsies was used, and all palsies were separated into five different types. A total of 304 patients with Bell's palsy were examined. The recurrent ipsilateral attacks (i.e., the unilateral recurrent palsies) showed a worse prognosis when compared with the non-recurrent palsies. In contrast, the recurrent attacks involving the contralateral facial nerve (bilateral alternating palsies) presented a better facial recovery. In reviewing the recurrent cases, the stapedial reflex demonstrated no prognostic value. Our results suggest that in presenting data of Bell's palsy it is advisable to differentiate the recurrences from the common (non-recurrent) palsies.     

Clinical experiences with recurrences of Bell's palsy

Summary In a retrospective study of 2568 patients with peripheral facial palsies seen during a 10-year period, 106 (8.2%) of 1293 patients (50.4%) with Bell's palsy suffered a recurrence. A recurrence at the same side of the face was called a recurrent one, but was considered to be an alternating one at the other side. Ninety-eight patients (52 men, 46 women) were studied for this report. Of these patients, 70% suffered from a second attack of Bell's palsy within 10 years of the first attack. Fourteen patients had more than one recurrence. Of some note, 33 of the 98 patients had their second palsy in the last months of the year. Recovery of facial function after a recurrent palsy was worse in 39.6% and was 32.1% after an alternating palsy. The recovery after multiple palsies appears to be worse than after a single palsy.     

威利坦缓释片在孕妇急性贝尔面瘫中的应用

目的 孕妇面瘫是临床棘手的难题,由于患者处于特殊生理阶段,用药选择时需考虑胎儿的安全.本研究的目的旨在寻找一个能在孕期使用的有效治疗面瘫的药物.方法 对2007年3月至2010年6月我院接诊的孕妇急性贝尔面瘫患者,给予威利坦缓释片每次800 mg、每日2次口服治疗,能坚持服药10天者共计21人,治疗前后用Sunnybrook评分系统进行评分,对疗效和不良反应进行记录和统计分析.结果 本组威利坦缓释片面瘫治愈率达76.2％,另有5人疗效较差,仅有1例出现胃肠道不良反应.结论 孕妇急性贝尔面瘫患者使用威利坦缓释片治疗10天是安全有效的,可以作为一种新的保守治疗方法.     

Bell's palsy — A new concept of treatment

Summary A report is given on preliminary results of an infusion therapy which, in contrast to presently used conservative forms of treatment, is based on both an antiphlogistic and a Theological effect of high doses of cortisone in combination with dextrane plus pentoxifylline.In more than 50% of the patients, clinical and electromyographical improvement of nerve function is observed already during infusion. Compared to other conservative therapeutic procedures, the frequency of resulting complete recoveries is 7–10% higher according to clinical criteria and 10–18% higher as judged by neurophysiological parameters. Compared to the spontaneous outcome, complete recovery ranges 20% higher in our series.Facial nerve decompression seems therefore no longer justified, as little as therapeutic nihilism.     

贝尔面瘫的味觉变化与临床疗效观察

采用电味觉仪和面神经电图对两组各２８例贝尔面瘫患者治疗过程进行了连续、同步观察,通过对味觉的种类（辣、苦、咸、麻）和味觉阈以及面神经功能的动态变化,发现味觉变化先于面神经功能的变化。联合治疗组结合中医味觉辨症,其疗效优于对照组（Ｐ〈０．０５）,并为贝尔面瘫的及时治疗和预后提供了客观依据。     

Conservative treatment of Bell's palsy with steroids and dextran-pentoxiphylline combined therapy

Summary In 1980, Stennert proposed for the treatment of Bell's palsy an infusion therapy consisting of initially high dosages of steroids in combination with low-molecular dextran and pentoxiphylline. Excellent results were reported as a consequence of administering this treatment scheme. This steroid-dextran medication was modified (SD therapy) and administered in 172 cases of Bell's palsy. The results were compared with those of a group of 59 patients who had been treated with orally administered low-dose steroids in combination with vasodilators, adenosine triphosphate and vitamins. All patients with incomplete palsies recovered completely, regardless of the mode of treatment. In cases of complete palsy, 87% of patients recovered completely when treated with SD therapy. In contrast, 68% of the patients treated with orally administered steroids recovered completely.This study was presented at the 14th World Congress of Otorhinolaryngology, Madrid, Spain, 10–15 September 1989 Offprint requests to: M. Kinishi     

A comparison of transcranial magnetic stimulation with electroneuronography as a predictive test in patients with Bell's palsy

The aim of this study was to examine the neuronographic findings of electrical and transcranial magnetic stimulation of the facial nerve and to compare their ability to predict clinical recovery from idiopathic facial nerve palsy (Bell's palsy). Eighty-six patients were examined clinically and neurophysiologically immediately on presentation to Tampere University Hospital. Electroneuronography (ENoG) and transcranial magnetic stimulation (TMS) were performed 1–6 times for each patient. The time interval between each examination varied from 2 to 7 days. Seventy-eight patients were followed for a median period of 13 months after the onset of palsy. Facial nerve function was graded according to the House-Brackmann grading system. Relative amplitude differences of ENoG and TMS during the acute phase were then correlated with clinical outcome. Statistical analysis of the results showed that a TMS response elicitable during the first 5 days of the palsy was correlatable with a good prognosis. ENoG results correlated with clinical outcome at a later time from onset of symptoms. TMS was well tolerated and no adverse effects were seen. These results indicate that TMS is a useful method for the early prediction of outcome in patients with Bell's palsy.     

Effects of meteorological factors on the onset of Bell's palsy

Objective

The etiology of Bell's palsy (BP) has not yet been clarified, although viral infection or reactivation is probably a major cause. The objective of this study was to evaluate the effects of meteorological factors on the onset and incidence of BP.

Methods

Meteorological data from 2007 to 2011 were obtained from the Web-based ‘Monthly Weather Reports of the Meteorological Administration’ database. Patients with BP who attended Incheon St Mary's Hospital during the same period, presenting on the precise day that their symptoms appeared, were included in this retrospective chart review. Twelve meteorological factors were compared for days on which BP onset was and was not observed. The weather conditions occurring 1–7 days before BP onset (D₋₁–D₋₇) were included to assess any possible delayed effects of meteorological factors on the onset of BP. The seasonal and monthly distributions of BP were evaluated.

Results and conclusion

The mean values for the meteorological parameters did not differ significantly between the days when BP onset did and did not occur. However, the maximum wind speed on day −1 (D₋₁) was significantly higher for BP onset days than for days with no BP onset. The seasonal and monthly distributions of BP did not differ significantly. It is suggested that stronger wind speed of preceding day may be related to the occurrence of BP.